A new real-time, interactive cardiac magnetic resonance imaging system (RTIS) has been developed. The RTIS allows continuous dynamic acquisition, interactive selection of any scan plane, and real-time image display at 16 frames/second (6 complete images/second) without cardiac gating or respiratory breath-holding. A clinical trial of the RTIS demonstrates that the system provides clinically reliable evaluation of LV function. The goal of this proposal is to use the RTIS technology to develop a new imaging protocol for a comprehensive diagnosis of ischemic heart disease. The RTIS platform will be augmented by imaging sequences for coronary artery, stress-induced wall motion, and myocardial perfusion. The first phase will focus on optimizing each imaging sequence. Each optimization will be validated by systematic comparison to the respective diagnostic gold standard. High-resolution coronary artery imaging sequence will allow immediate screening, localization, and visualization of the desired coronary artery. Frame rate of 30 complete images/second will provide imaging of stress induced wall-motion in tachycardia range. Cardiac-gated single shot imaging will enable rapid acquisition of several frames per systole over multiple planes to cover the entire heart for first- pass perfusion imaging. The second phase will consist of a prospective clinical trial of each optimized sequence. During the final phase, the 3 imaging sequences will be integrated seamlessly into the RTIS to test the clinical utility of a rapid and robust comprehensive cardiovascular diagnostic system (CVMR). The wide range of tissue contrast mechanism of MRI creates a huge potential in cardiovascular imaging. Robust imaging sequences have been developed to display physiologic parameters to diagnose cardiac ischemia. The major thrust of this research plan is to develop an advanced, integrated imaging system to test the hypothesis whether such comprehensive approach will enhance non-invasive diagnosis of ischemic heart disease. The final product will be a diagnostic system that maximizes the MR tissue contrast properties coupled with real-time interactive capabilities and easy, intuitive user-interface. The CVMR will demonstrate optimal transfer of innovative technology to cardiovascular medicine.